Timothy D. McBride, PhD

Phone: 314.935.4356
Email: tmcbride@wustl.edu

Washington University in St. Louis
One Brookings Drive
St. Louis, MO 63130


Current Projects - (1)

Health Insurance Marketplaces, Medicaid, and Uncompensated Care: The Rural Impact
This project provides an in-depth analysis of Health Insurance Marketplace (HIM) plan design, specifically measuring the availability and prevalence of high-deductible plans in rural as compared to urban areas.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health disparities, Health insurance and the uninsured, Health policy, Medicaid and S-CHIP

Completed Projects - (14)

Analysis of Medicare Advantage Quality in Rural Areas: Historically and Moving Forward
This project examines the role that geography and demographics play in the success and quality of different types of MA plans in particular regions of the country.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA)
Analysis of Trends in Characteristics of Rural Beneficiaries Enrolling in Medicare Advantage Plans
This study will compare characteristics of rural and urban beneficiaries enrolling in Medicare Advantage (MA) plans, including their age, health status, income, and race/ethnicity. We will analyze the consequences of increasing use, promoted by policy choices, of a market-based approach in the Medicare program.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Medicare Advantage (MA), Rural statistics and demographics
Do Communities Make a Difference in Access? A National Study
This project will examine the effect of community-level resources on an individual's access to health care, particularly whether urban and rural individuals' access to health care differs, given community differences.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health services
Effects of Changing Medicare Advantage Landscape on Rural Enrollees
The goal of this project is to assess the impact of changes in Medicare payment policy on the availability of choices for rural Medicare beneficiaries. The objectives are quantify the impact of payment policy on the number of competing plans in strata of rural counties and the effects of using quality star ratings on choices in rural counties.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA)
Estimating the Medicare+Choice Threshold Payment Rate
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Healthcare financing, Medicare
Expanding Rural Health Insurance Coverage: How Do Insurance Reform Strategies Stack Up?
This purpose of this study is to inform policymakers about the current state of health insurance coverage in rural America, and to assess how specific reform strategies may differentially affect rural residents. Using a combination of analytic strategies, we will provide policymakers and rural health advocates with the necessary tools to develop reform strategies that meet the needs of rural residents.
Research centers: Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Health policy
How will plan Offerings and Premiums Change in Rural and Urban Areas in the Second Year of Health Insurance Marketplaces?
This project analyzes changes in Health Insurance Marketplaces plan and premium data between 2014 and 2015 by geographic region.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health insurance and the uninsured
Impact of Medicare Advantage Plan Concentration on Choices and Competition in Rural Areas
This project focuses on the analysis of Medicare Advantage (MA) plan choices for rural beneficiaries and what the concentration of plan choices in rural areas may mean in the context of how rural beneficiaries are making their choices. Using measures of concentration from the economics literature, this project will explore the relationship between market concentration in MA plans and the generosity of MA plans, and how it varies by the location of residence of Medicare beneficiaries.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA)
Implementation of the Medicare Prescription Drug Benefit: What is Available to Rural Beneficiaries?
This study will focus on the impact of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on rural beneficiaries, based on actual prescription drug plan contracts, comparing the impact of the legislation on rural beneficiaries to their urban counterparts.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health policy, Legislation and regulation, Medicare Part D
State Policy Issues That May Impact HIMs’ Success in Rural Places: A Regional Analysis
Goals of this project include gathering detailed data and providing analysis and policy recommendations on issues relating to network adequacy and service areas for HIMs, with additional investigation of other state-level policy variables (such as the Medicaid expansion decision) which may have a confounding or moderating effect on the relationship between network adequacy and enrollees’ choices and premiums.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health information technology, Health insurance and the uninsured, Health policy, Legislation and regulation, Medicaid and S-CHIP, Technology, Telehealth
Trends in Medicare Advantage Quality and Enrollment: The Effects of Quality Based Payment Incentives on Rural People and Places
This research will analyze the quality of Medicare Advantage (MA) plans offered to rural MA beneficiaries currently, in relation to urban beneficiaries, and how it has evolved over the past four years. In addition, the effect of quality-based payment incentives will be measured by: 1) changes that have been made to improve the quality of existing plans in rural areas or to encourage the entry of high quality plans into rural areas, and 2) the movement of plans’ entry and exit into the MA market by plan type and rural/urban location.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Medicare, Medicare Advantage (MA)
Uninsurance and Welfare Reform in Rural America
This project used widely accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. Additionally, the project concentrated on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period when welfare reform was phased in.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Poverty
Why Are Health Care Costs Increasing and Is There a Rural Differential in National Data?
This project will determine whether growth in health insurance premiums and out-of-pocket spending differs in rural areas as compared to urban areas.
Research center: RUPRI Center for Rural Health Policy Analysis
Topic: Health insurance and the uninsured
Will Health Insurance Marketplaces Deliver Affordable Options in Rural America
This project analyzes early Health Insurance Marketplaces plan and premium data by geographic region, controlling for state policy decisions, to assess the degree to which affordable health insurance will be available through individual and/or small business marketplaces.
Research center: RUPRI Center for Rural Health Policy Analysis
Topics: Health insurance and the uninsured, Health policy

Publications - (72)

  • 2012 Rural Medicare Advantage Quality Ratings and Bonus Payments
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2014

    Analyzes differences in rural Medicare Advantage (MA) quality ratings and payments and suggests reasons why quality ratings vary by geography. Overall, the quality rating of MA plans in rural areas is lower than in urban areas, a result of the availability of, and enrollment in, different types of MA plans.

  • 2014: Rural Medicare Advantage Enrollment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2015

    Rural Medicare Advantage (MA) and other prepaid plan enrollment in March 2014 was nearly 1.95 million, or 20.3 percent of all rural Medicare beneficiaries, an increase of more than 216,000 from March 2013. Enrollment increased to 1.99 million (20.4 percent) in October 2014. MA enrollment increased in both rural and urban areas despite reductions in payment and the conclusion of the MA bonus payment demonstration at the end of 2014.

    Some rural counties were reclassified, due to a change in population, and nearly 10 percent of the previously rural MA population is now considered urban; however, the percentage of the rural Medicare beneficiaries enrolled in MA did not change significantly. The majority of growth in rural MA enrollment was in Preferred Provider Organization plans, with over 56 percent of enrollment, while nearly a third of beneficiaries were enrolled in Health Maintenance Organization plans.

  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of “potential market” participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.
  • After Hospital Closure: Pursuing High Performance Rural Health Systems without Inpatient Care
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2017
    A new paper describing opportunities for rural communities to develop a high performance rural health system after hospital closure, including three case studies that describe real-world transitions from hospital-based locus of care to new models of care delivery in rural places.
  • Analysis of Availability of Medicare+Choice, Commercial HMO, and FEHBP Plans in Rural Areas: Implications for Medicare Reform
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2003
    Examines viability of introducing private competition into the Medicare program. Discusses availability of Medicare+Choice1 (M+C), commercial HMO, and Federal Employees Health Benefits Program (FEHBP) plans in rural (nonmetropolitan) counties.
  • April 2009 Rural Enrollment in Medicare Advantage: Growth in PPOs Outpacing Growth in PFFS
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2009
    Private fee-for-service (PFFS) plans dominate enrollment in rural areas and have accounted for much of the program's expansion since 2005. However, from December 2008 through April 2009 enrollment growth of preferred provider organization (PPO) plans, both nationally and in rural areas, was double the enrollment growth of PFFS plans.
  • Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
  • Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
  • Availability and Use of Health Plan Choices in Rural America: Medicare+Choice, Commercial HMO, and Federal Employees Health Benefit Program Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2003
    Discusses availability of Medicare + Choice (M+C), commercial HMO, and Federal Employee Health Benefit Program (FEHBP) insurance plans, and the potential impact of M+C service delivery area changes on health care access in rural areas.
  • Care Coordination in Rural Communities Supporting the High Performance Rural Health System
    Report

    Date: 06/2015

    Care coordination has emerged as a key strategy under new healthcare payment and delivery system models that aspire to achieve Triple Aim objectives—better patient care, improved population health, and lower per capita cost. Achieving these objectives requires conceptualizing and planning care delivery in a new way that not only involves coordinating medical care, but helping people get the care and the support services they need to address the “upstream” social determinants of health. In rural places, these are especially important considerations. While care coordination models vary, all include multidisciplinary teams and networks, a person-centered focus, and timely access to and exchange of information. The purpose of this paper is to examine care coordination programs and processes that affect rural people and places to discover what is happening now in rural communities, how different programs and approaches are working, who benefits, and make policy recommendations that will facilitate care coordination efforts in support of high performance rural health system development.

  • Changing Rural and Urban Enrollment in State Medicaid Programs
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-ACA. Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas.
  • Comments on the June 2001 Report of the Medicare Payment Advisory Commission: Medicare in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2001
    Comments on and critiques the findings in MedPAC's Medicare in Rural America. The authors believe that while the MedPAC report helps set a framework for analysis, it is not a definitive treatise on the role of Medicare in rural health. Among its findings: most of MedPAC's recommendations would have positive impacts on health care for rural beneficiaries, others would do no harm, others could be strengthened, and a few, particularly those relating to access to services, "suffer from disparities and weaknesses." Report produced by the RUPRI Rural Health Panel.
  • The Current and Future Role and Impact of Medicaid in Rural Health
    Rural Policy Analysis and Applications
    Date: 09/2012
    Outlines and describes the current Medicaid program and its importance to rural America. Also discusses rural implications of program expansion, including whether and how states choose to implement changes.
  • December 2009: Rural Medicare Advantage Enrollment Grows 15% in 2009
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2010
    Rural enrollment in Medicare Advantage (MA) and other prepaid plans grew by 15% from December 2008 to December 2009, faster than the 10% national growth rate. Preferred provider organization plans drove the increased enrollment in MA plans in rural areas in 2009, while private fee-for-service (PFFS) plans continued to dominate the market with over 50% of enrollment. This landscape could change in 2010 as rural Medicare beneficiaries will experience a decline in PFFS availability, as some insurers have announced plans to pull their PFFS plans from the market.
  • Designing a Prescription Drug Benefit for Rural Medicare Beneficiaries: Principles, Criteria, and Assessment
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    The purpose of this paper is to offer a rural perspective on the current debate over the design and implementation of a Medicare prescription drug benefit. Background information on rural Medicare beneficiaries' need for, and access to, prescription drugs is provided, along with a set of rural-oriented principles for use in evaluating how different prescription drug proposals may meet the needs of rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Eligible But Not Enrolled? Potential for Targeting Over a Half-Million Rural Medicare Beneficiaries for Enrollment in the Low-Income Subsidy Prescription Drug Program (Policy Brief)
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2008
    The Medicare Part D low-income supplement (LIS) is designed to help low-income persons access the prescription drug benefit with reduced premiums and lower out-of-pocket costs. To date, estimates suggest that almost 80% of the persons eligible for the LIS are participating in the program. But despite efforts by CMS and its partners to enroll as many eligible persons as possible, 5.6% of rural Medicare beneficiaries and 3.7% of urban Medicare beneficiaries are estimated to be eligible for but not enrolled in the LIS program. Information in this brief and the accompanying state tables could help CMS partners (including state and county agencies) target counties with high likelihood of identifying and enrolling LIS-eligible beneficiaries. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research. Report available by contacting the Center.
  • Enrollment in FEHBP Plans In Rural America: What Are The Implications For Medicare Reform?
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2003
    Recent proposals to reform the Medicare program and add an outpatient prescription drug benefit have used the Federal Employees Health Benefits Program (FEHBP) as the model for how private plans could be incorporated into the Medicare program. This policy brief presents information showing how FEHBP is functioning in rural areas of the country. Enrollment patterns into the various options available in the FEHBP, descriptions of the choices typically available in rural areas, and location of primary care providers used by plans in a sample of rural communities is presented.
  • Enrollment in FEHBP Plans in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    Study of health plan enrollment decisions made by rural retirees and federal workers. Discusses how a Federal Employees Health Benefit Program (FEHBP) plan may work when applied to Medicare. Report available by contacting the Center.
  • Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2007
    Provides updated findings about Medicare beneficiary enrollment in prescription drug plans (PDPs) in rural and urban areas across the United States.
  • Enrollment in the Federal Employees Health Benefit Program (FEHBP): State and County-Level Enrollment Analysis
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2003
    Information on Federal Employees Health Benefit Program (FEHBP) enrollment in rural counties, including the number of health insurance plans available and number of enrollees. FEHBP is being considered as a model for involving private insurers in Medicare. Rural FEHBP enrollment choices may provide insights into how a similar program might work for Medicare. Report available by contacting the Center.
  • February 2010: A Dramatic Shift Away from Private Fee-for-Service Plans in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2010
    In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. Nationwide, enrollment in preferred provider organization and health maintenance organization plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010.
  • The Federal Employees' Health Benefits Program: A Model for Competition in Rural America?
    RUPRI Center for Rural Health Policy Analysis
    Date: 2005
    Tests the hypothesis that the Federal Employees' Health Benefits Program (FEHBP) has fostered an environment of competing health plans, especially preferred provider organizations (PPOs), in rural areas.
  • Geographic Variation in Premiums in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2014

    This Policy Brief analyzes the 2014 premiums of health insurance plans available in the new marketplaces created by the Affordable Care Act. Using methodology developed in an earlier Policy Brief, we find that initially, a state-based marketplace design and an “MSAs+1” rating area design are associated with lower average premiums. Rating areas with more than 1000 people per square mile also tend to have the lower premiums. We find that the rating areas with the highest average premiums are characterized by smaller populations, greater land areas, and far fewer health providers per square mile.

  • A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2014

    Provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments.

  • Health Insurance Marketplaces: Early Findings on Changes in Plan Availability and Premiums in Rural Places, 2014-2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015

    Analysis of nationwide county-level Health Insurance Marketplace plan and premium data for 2014 and 2015 provides evidence that many low-density rating areas are gaining firms and that average premium growth is low in many rural areas. However, premium growth is somewhat higher in low-density rating areas, and a small minority of rural states have experienced large average premium increases. Thus there is no systematic pattern to rural experiences of HIMs, although some isolated places may be at risk for weak outcomes.

  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • The High Performance Rural Health Care System of the Future
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    Describes a future rural system that would be built on foundations of affordability, accessibility, community focus, high quality, and patient centeredness.
  • Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    The 2008-09 recession has impacted the United States in many profound ways, but perhaps most dramatically through increased unemployment. Job loss for many means loss of employer-sponsored health insurance or ability to purchase individual insurance. Some individuals can obtain coverage through Medicaid or private health insurance, but many remain uninsured. This brief presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas over the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas.
  • The Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2005
    Explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons over the period when the reform was phased in.
  • Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
  • Inequitable Access: Medicare+ Choice Program Fails to Serve Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2002
    This brief discusses the Medicare+ Choice plan and how it has failed to meet the health issues of Americans.
  • July 2009: Rural Enrollment in Medicare Advantage Continues to Grow
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2009
    Rural enrollment in Medicare Advantage continues to grow, with growth in the last 18 months led by the growth of preferred provider organization (PPO) plans. Despite the growth in PPO plans, private fee-for-service plans continue to dominate enrollment in rural areas and have accounted for much of the program's growth since 2005.
  • June 2011: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    Shows increases in enrollment into Medicare Advantage plans in rural America. The enrollment is concentrated in plans offered by three firms, especially in the types of plans with high rural enrollment which are preferred provider organizations and private fee-for-service plans.
  • June 2012: Rural MA Enrollment and Premium Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2013
    Medicare Advantage (MA) enrollment continued to grow and premiums continued to decline in 2012 despite reductions in payment to the plans as mandated by the Affordable Care Act. Rural MA enrollees face higher premiums than their urban counterparts, and the average premium for rural MA beneficiaries fell to $48 per month in 2012 as compared to $52 per month in 2011.

    Analysis of the zero premiums by plan in relationship to the plans charging a premium gives additional insights into the MA marketplace as faced by rural enrollees. Zero premium plans are less available in rural areas and are selected less often when they are available, which is a potential source of inequity between rural and urban areas.

  • March 2011: Growth in PPOs Dominates the Rural MA Market in 2011
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2011
    From March 2010 to March 2011, rural Medicare Advantage (MA) enrollment in preferred provider organization plans grew from 28% (396,006 enrollees) to 46% (702,315 enrollees) of total enrollment, while rural MA enrollment in private-fee-for-service plans fell from 38% (530,678 enrollees) to 16% (249,499 enrollees).
  • March 2012: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2012
    Presents key findings on Rural Medicare Advantage (MA) enrollment and on Rural Preferred Provider Organization (PPO) enrollment.
  • March 2013: Medicare Advantage Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 09/2013
    Policy brief discussing current rural Medicare Advantage enrollment data.
  • May 2009: PPOs Driving Growth in Rural Medicare Advantage Enrollment
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009
    A changing landscape is emerging for rural Medicare Advantage (MA) enrollment in 2009 as rapid growth in preferred provider organization (PPO) plan enrollment is coupled with a decline in the growth rate of enrollment in private fee-for-service (PFFS) plans. Enrollment in MA plans has continued to climb in 2009, but it has been impacted by the slowed rate of growth in PFFS plans, which cover over half of MA enrollees in rural areas. The growth in PPO enrollment in recent months is likely tied to changes in policy that have encouraged the growth of new PPO plans, enrollment in existing PPO plans, and expansions of the service areas of existing plans.
  • Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2006
    Provides a first snapshot of enrollment in Medicare Part D in rural and urban areas across the United States and outlines the early findings from an analysis of plans available to rural persons under this program.
  • Medicare Physician Payment Policy and the Rural Perspective (Final Report)
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2008
    During the past six years, the RUPRI Center has examined the effects of Medicare payment changes on rural physician practice revenue. Despite the apparently tenuous association between Medicare physician payment policy and physician practice decision making, we infer that changes to practice revenue potentially affect physician decisions regarding rural practice. This report presents the results of the RUPRI Center's work and provides a framework for understanding this continuing policy question.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2006
    Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Medicare Physician Payment: Practice Expense
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2003
    Examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment methodology warrants careful validation to demonstrate that the index measures actual geographic practice cost differences. A complete understanding of the reasons for different payments will inform both physicians who want to know why the same procedure results in less reimbursement in one place than it does in another and policymakers who want to address that concern.
  • Medicare Value-based Payment Reform: Priorities for Transforming Rural Health Systems
    Report
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2015

    In January, 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms (DSR) by making health care organizations more accountable for patients’ health as well as population and community health. Payment and delivery system reform, however, is concentrated in urban centers, and Medicare rural payment policies that were designed to strengthen rural health providers and systems are now complicating payment and delivery system reform in rural areas. The inclusion of rural providers in Medicare payment reform is critical for the program and for the 23 percent of Medicare beneficiaries who reside in rural areas. Rural Medicare beneficiaries should have the same opportunity as their urban counterparts to benefit from payment reform’s positive effects including strengthened primary care, embedded care coordination, and improved clinical quality. In this paper, we describe five recommendations to facilitate rural inclusion in value-based payment and delivery system reform:

    1. Organize rural health systems to create integrated care.
    2. Build rural system capacity to support integrated care.
    3. Facilitate rural participation in value-based payments.
    4. Align Medicare payment and performance assessment policies with Medicaid and commercial payers.
    5. Develop rural appropriate payment systems
  • Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
    Rural Policy Analysis and Applications
    Date: 09/2010
    Summarizes six issue areas of the Affordable Care Act (ACA) and discusses implications for access to services and improving the health status of rural residents. These issue areas are: health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
  • Patterns of Health Insurance Coverage Among Rural and Urban Children
    Maine Rural Health Research Center
    Date: 11/2001
    Assesses differences in the patterns of insurance coverage and uninsured spells among rural and urban children in 20 states. Also examines the implications of those differences for the design and implementation of public insurance programs. Among its findings: Although the average duration of new uninsured spells was shorter among rural than urban children, rural children were more likely to experience protracted spells of uninsurance. Rural children were also more likely than urban children to move between public and private coverage. These findings have important implications for designing insurance expansion programs and outreach strategies to effectively enroll and retain rural children.
  • Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2001
    Provides a framework to help shape proposals to redesign Medicare to the benefit of rural beneficiaries and providers. Chapters focus on equity, quality, choice, access, and cost. Each chapter outlines the current situation, analyzes the implications of various approaches to changing the program, and makes recommendations for developing a Medicare program of greatest benefit to rural residents. Report produced by the RUPRI Rural Health Panel.
  • Redesigning the Medicare Program: An Opportunity to Improve Rural Health Care Systems?
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2000
    With this paper, the RUPRI Rural Health Panel is presenting a well-defined framework for what should be included in any discussion of Medicare policies.
  • Report on Enrollment: Rural Medicare Beneficiaries in Medicare+Choice Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2000
    This policy brief describes the experience to date with the Medicare+Choice program, focusing on changes in enrollment and plan formation through Fall 1999. Report produced by the RUPRI Rural Health Panel.
  • Rural Assessment of Leading Proposals to Redesign the Medicare Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2000
    This Policy Paper provides a critique of two proposals to redesign the Medicare program: the "Medicare Preservation and Improvement Act of 1999" (S. 1895, introduced by Senator Breaux and others) and "The President's Plan to Modernize and Strengthen Medicare for the 21st Century." Rural implications of the proposals are discussed, specifically how they affect rural Medicare beneficiaries and rural providers of health care services. Report produced by the RUPRI Rural Health Panel.
  • Rural Enrollment in Health Insurance Marketplaces
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2015

    This brief provides analysis of Health Insurance Marketplace enrollment outcomes for 2015 at the rating area and county levels. Enrollment rates are reported by number of firms participating and for multiple geographic categories: population density, Census region, and metropolitan status of the county. Rural rates are similar to urban rates in many places, but areas of concern exist and may benefit from additional outreach in the future.

  • Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2015

    In this brief, we provide comparisons between cumulative enrollment totals in Health Insurance Marketplaces in metropolitan and non-metropolitan areas of each state and corresponding percentages of “potential market” participants enrolled, controlling for Medicaid expansion status. We show that in several states, non-metropolitan enrollment rates exceed metropolitan enrollment rates, a finding that is obscured in an aggregate comparison. This analysis provides some indication of how well outreach and enrollment efforts targeting rural populations are proceeding in the states.

  • Rural Enrollment in Medicare Advantage Continues to Grow Rapidly in 2008, Led by Private Fee-for-Service Plans
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2008
    Enrollment of rural beneficiaries into Medicare Advantage (MA) plans has more than quadrupled since the inception of the MA program at the beginning of 2006 and increased 35% in the last year. However, as a percent of all beneficiaries, the enrollment rate in rural areas remains well below the national enrollment rate. The tremendous growth in rural MA plans over the past two and a half years is mostly attributed to the spread of private fee-for-service plans across the country, which now account for 58% of rural Medicare eligibles. This policy brief provides findings about enrollment in the MA program in rural areas and across the United States and updates findings from analysis of the MA program presented in previous RUPRI Center policy briefs. Funded by the Office of Rural Health Policy: Cooperative Agreement for Rapid Response to Issue-Specific Rural Research. Report available by contacting the Center.
  • Rural Enrollment in Medicare Advantage Growing Rapidly in 2007, Especially in Private Fee-for-Service Plans
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2007
    Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas, with state and national data.
  • Rural Enrollment in Medicare Advantage Is Concentrated in Private Fee-for-Service Plans
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2007
    Provides findings about enrollment in the newly designed Medicare Advantage (MA) program in rural and urban areas. Includes rural and urban data on enrollment in Medicare Advantage and other pre-paid plans by type of plan. Also provides state-level information on MA enrollment.
  • Rural Enrollment in Medicare Advantage: Growth Slows in 2008
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2009
    The rate of growth of enrollment in the Medicare Advantage program decreased significantly in 2008, compared to previous years. In addition, the growth rate in preferred provider organization plans in rural areas now exceeds that in private fee-for-service plans. This policy brief updates earlier findings from analysis of the MA program reported by the RUPRI Center. Report available by contacting the Center.
  • Rural Medicare Advantage 2011: Enrollment Trends and Plan Characteristics
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2011
    This paper report findings from analysis of the Centers for Medicare and Medicaid Services data to examine the trends and geographic variations in Medicare Advantage (MA) plan enrollment, premiums and market concentration by firm. MA enrollment in rural areas remains strong and continues to grow in 2011, despite the recent shift in enrollment from private fee-for-service plans to preferred provider organization plans. The data presented in this policy brief provide an overview of the Medicare Advantage program in rural America and highlight key rural/urban differences within the program.
  • Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2016
    There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. This brief suggests that policy interventions may be necessary to improve the quality of MA plans in rural areas.
  • Rural Medicare Advantage Plan Payment in 2015
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2016
    Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA). This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant.
  • Rural Medicare Advantage: Modest Enrollment Growth in 2010
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2010
    Despite a slight drop in enrollment and a dramatic shift in the landscape of the rural Medicare Advantage (MA) market in early 2010, MA plans have experienced modest growth in enrollment in rural areas over the last two quarters of 2010. The majority of the growth is concentrated in preferred provider organization plans, counteracting a decline in private fee-for-service plan enrollment.
  • Rural Physicians' Acceptance Of New Medicare Patients
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Findings from analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians indicate that: 1) The trend among all physicians is to not accept new Medicare patients, 2) The percentage of physicians in both urban and rural areas who are accepting new Medicare patients is declining, 3) Physicians practicing in rural areas not adjacent to urban areas are the most likely to accept new Medicare patients, and 4) Findings also indicate that the negative implications of not taking the necessary steps to reverse the small but important decline in physician willingness to take new Medicare patients may be most serious in rural communities.
  • A Rural-Urban Comparison of a Building Blocks Approach to Covering the Uninsured
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2009

    A range of proposals are now being considered to reform the health care system, specifically to provide access to health insurance coverage for the uninsured. Proposals include a range of public-private approaches, typically called "building blocks" approaches, which build upon our current system of health insurance to provide access to health insurance for all Americans. This brief uses a RUPRI health insurance model to compare the effects of a building blocks approach on health insurance coverage and health spending, focusing on the geographic differences (by metropolitan and non-metropolitan) of this approach.

  • Rural/Urban Analysis on Individual Insurance Market Topics
    Fact Sheet
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers.
  • Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act
    Rural Policy Analysis and Applications
    Date: 12/2010
    The ACA calls for the development of a National Health Care Quality Strategy and Plan (National Quality Strategy) that will affect healthcare that is delivered to millions of Americans who live in rural areas and thousands of healthcare providers who care for them.
  • September 2010: Rural Medicare Advantage Enrollment Update
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2010
    Rural enrollment in Medicare Advantage (MA) plans grew to nearly 1.5 million enrollees in September 2010 (15% of eligible Medicare beneficiaries), while national MA enrollment grew to over 11.5 million (25%). Rural Medicare beneficiaries will find fewer options for MA health insurance coverage in 2011- an average of 16 MA plans to choose from, compared with 24 plans on average in 2010.
  • September 2012: Medicare Advantage Enrollment Update
    Rapid Response to Requests for Rural Data Analysis
    Date: 04/2013
    Policy brief discussing current rural Medicare Advantage enrollment data.
  • Stand-Alone Prescription Drug Plans Dominated the Rural Market in 2011
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2012
    Reports that as of May 2011, 59.1% of rural Medicare beneficiaries were enrolled in Medicare Part D through insurance plans that provide coverage for prescription medications. Provides further detail of enrollment, including urban and rural enrollment by type of plan and by state.
  • Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
    Maine Rural Health Research Center, RUPRI Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
    Date: 2005
    The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in 2004 to identify a set of researchable questions concerning rural healthcare.
  • The Uninsured: An Analysis by Age, Income, and Geography
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2014

    Using the 2010 Small Area Health Insurance Estimates (SAHIE), we analyze the rural and urban uninsured populations by age, showing that in both places, uninsured rates decline dramatically with age. We find that, within each age group, rural uninsured rates are somewhat lower than urban uninsured rates at income levels below 400% of the Federal Poverty Level. However, since a greater proportion of the rural population falls into the age and income categories with high uninsured rates, rural people as a group stand to benefit slightly more from subsidized coverage through the Health Insurance Marketplaces (HIM) or Medicaid expansion (if enacted). Furthermore, we discuss the potential for age differences between rural and urban uninsured populations to drive HIM premiums upward, an effect which may be mitigated or compounded by various other factors.

  • The Uninsured: An Analysis by Income and Geography
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    Reports that a larger proportion of the rural population than the urban population is uninsured and low income. A larger proportion of the rural population than the urban population will be eligible for subsidized Health Insurance Marketplace coverage due to income levels and current lack of insurance.
  • Update on Medicare+ Choice: Rural Medicare Beneficiaries Enrolled in Medicare+ Choice Plans through September 2001
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2002
    Medicare+ Choice Plans, counties enrolled, and data available.
  • Update on Rural Enrollment in Medicare Advantage: Growth Continues
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2007
    Provides findings about rural enrollment in the Medicare Advantage (MA) program and other pre-paid plans, with state and national data.
  • Why are Health Care Expenditures Increasing and Is There a Rural Differential?
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2005
    Rising healthcare expenditures have disproportionately affected rural areas, and in recent years seen higher increases in some expenditure categories such as physician office-based visits and prescription drugs. Differences suggest strategies to contain health expenditure increases may be different in rural areas and determined on a local basis.